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Visiting Nurse Service of New York
Geriatric Nursing Competency in Home Care: A Clinical Training Program at the Visiting Nurse Service of New York (VNSNY)
Problem to be addressed:
Of all sectors of health care delivery, home care is the fastest growing. Irrespective of physical or functional decline, older people prefer to remain in their own home. As the largest, not-for-profit, non-governmental home care agency in the US, the Visiting Nurse Service of New York (VNSNY) delivers care to 30,000 patients daily throughout the five boroughs of New York City. Sixty four percent of these patients are over the age of 65, with the average age of patients at 73. The VNSNY offers an array of clinical programs to meet the complex and diverse needs of patients for acute, long-term and palliative care services at home.
The 2,560 Registered Nurses employed by VNSNY deliver direct care to patients, work closely with other professional staff (e.g. physical therapists and social workers), and supervise over 6,000 home health aides. It is imperative that these nurses be competent in care of older patients. Yet, within VNSNY, only a handful of nurses are certified in geriatrics, and VNSNY has no comprehensive training program to assure geriatric competency in their nurse workforce.
The VNSNY/Hartford Institute Project:
In 2008, VNSNY and the Hartford Institute for Geriatric Nursing at the NYU College of Nursing (Hartford Institute) (with partial funding from the NY City Department for the Aging and the Fan Fox and Leslie R. Samuels Foundation) began to collaborate on a pilot project to assure that VNSNY nurses were prepared in geriatrics. In the project’s first phase, in 2009, VNSNY educated 20 nurses working in the VNSNY Long Term Home Health Care Program (LTHHCP), the “Lombardi” program. The LTHHCP program, with over 3,000 patients enrolled, enables patients with chronic illness or disabilities to live at home instead of in a nursing home facility.
The goals for this pilot phase of the program (2009 and Spring, 2010) are to prepare 40 nurses from the >90 nurses in the Queens office of the VNSNY LTHHCP program (patient case load 1,509) in best practices in care of older adults. RNs completing the educational module will sit for the ANCC Gerontological Certification Exam. An evaluation plan is in place to evaluate the program effectiveness. Participants completing the 40 hours of the educational program receive Certificates of Completion from the Consortium of New York Geriatric Education Centers (CNYGEC).
Project Evaluation:
Program evaluation includes querying nurse trainees using two instruments:
1) Assessment of Geriatric Capacity in Home Care that assesses trainee attitudes and perceptions related to the care of older adults (a modification of an instrument used by NICHE hospitals)
2) a knowledge test of geriatric care. Trainees will complete both instruments before and after training. The number of VNSNY nurses participating in each training session and those sitting for the ANCC Certification Course will be recorded. The Nurse Administrator of the VNSNY LTHHCP is an active member of the Steering Committee for this project and will give feedback throughout the project. Participants also complete all of the evaluation instruments of the CNYGEC.
Training for VNSNY LTHHC nurses in best-practices in geriatric nursing:
The project that VNSNY and the Hartford Institute have developed and begun to implement builds on the nationally recognized training and clinical materials and models developed by the Hartford Institute (www.ConsultGeriRN.org; www.HartfordIGN.org), and the Hartford Institute NICHE program (Nurses Improving Care to Healthsystems Elders), specifically an evaluation tool of nurses perception of the environment to support competence in geriatric nursing care, and the Geriatric Resource Nurse (GRN) model which trains nurses in geriatrics who in turn become resources for units within the hospital.
The VNSNY program provides both traditional face-to-face synchronous training and asynchronous internet training to VNSNY nurses using nationally recognized evidence-based best practices training materials on the care of older adults developed by the Hartford Institute.
This training focuses on the major nursing needs of older adults in home care, including assessment and management of geriatric conditions and syndromes. Nurses will apply electronic resources accessible through portable tablet technology. The trainings use a blended approach of face-to-face live teaching and materials on the Hartford Institute clinical nursing website www.ConsultGeriRN.org.
Training for nurses to sit for the ANCC Gerontological Nursing Certification:
The American Nurses Credentialing Center (ANCC) offers a Gerontological Nursing Certification examination that is open to all RNs who successfully complete an examination and meet practice hour requirements. VNSNY will prepare 40 nurses from the LTHHC program to sit for this exam in 2 classes of 20, one in Spring and one in Fall 2008. VNSNY will conduct face-to-face trainings (2 hours /week over 12 weeks) with the last class focused on completing the ANCC application to sit for certification. VNSNY will reimburse nurses for the application fee to sit for the exam. The web-based certification review course available on www.ConsultGeriRN, will supplement the face-to-face trainings. Nurses will receive 40 hours of CEUs: 24 from the class and 16 from web materials.
Project Impact:
We anticipate that the project will have a substantial impact on the geriatric capacity of the nurse workforce at VNSNY. For the individual nurse exposed to geriatric best practices, the project should improve care by greater use of assessment and protocols for older adults. These nurses should more easily identify “abnormal” behavior or symptoms and thus make more timely referrals and head off untoward events.
Contact Information
Program Director: Mary Jo Vetter, RN, MS, NP-C, Director of New Clinical Product Development, Visiting Nurse Service of New York (VNSNY); 212 609-6358; 212 290-2167; maryjo.vetter@vnsny.org